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General NPI Number Information
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NPI Number | 1316892904
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Entity Type | Organization
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Legal Business Name | GDA FOR KIDS, INC
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Dates
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Enumeration Date | 02/28/2026
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Last Update Date | 02/28/2026
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Provider Practice Location Address
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Address Line | 2555 LINCOLN HWY STE 111
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1938
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Country | US
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Telephone | 708-679-0668
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Fax | 708-843-0656
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Provider Business Mailing Address
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Address Line | 2555 LINCOLN HWY STE 111
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1938
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Country | US
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Telephone | 708-679-0668
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Fax | 708-843-0656
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RONNIE A GORDON SR.
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Credential |
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Telephone | 708-466-2374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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